Credentialing helps the doctors/practices interested in participating with various insurances specific to his county/city/state. It is the process of review and verification of of the healthcare provider’s information.
Review and verification includes: current professional license(s), current Drug Enforcement Administration and Controlled Drug Substance Certificates, verification of education, post-graduate training, hospital staff privileges and levels of liability insurance.
The process begins with requesting Credentialing Application Kits from all the commercial and government health Insurances. After submitting the signed applications, we follow-up with the payers to retrieve the Provider ID# or Group ID# confirming that the provider is participating with the insurance. We also give bi-weekly status updates to the provider until an effective date of enrollment is determined so the provider can begin claim submission.